Canceled In California: People Eye Health Plans Off Exchange

Shoppers get ready to pay at Costco Wholesale in Mountain View, Calif. For the next couple of weeks, Californians whose insurance was canceled have some unusual options, including an Aetna plan available only at Costco.

Paul Sakuma
/ AP

Some Californians whose policies have been canceled are finding relief in a surprising place: from insurance companies that aren't offering plans on the new Covered California marketplace.

Earlier this year, Aetna announced it would bow out of the state's individual market, effective Dec. 31. Cigna is staying, but isn't offering any products on the exchange. Right now, both companies are accepting new customers into pre-Affordable Care Act plans.

Anne Gonzales, a Covered California spokeswoman, confirmed that a carrier not offering plans on Covered California "could offer a noncompliant plan through 12/31/2013 but it would need to become compliant when it renews next year."

So, consumers can enroll now, but when the policy comes up for renewal in 12 months, the plans would need to come into compliance with the ACA — and premiums would almost certainly go up. Plans could be noncompliant for a variety of reasons, including that they don't provide free preventive care or they charge people more if they have a preexisitng condition.

Jason Andrew, CEO of Stone Meadow Benefits & Insurance Associates, says he has "tons of letters" on his desk from clients who have received notice that their policies were canceled. The policies they have been offered are "all more expensive and not as good of coverage," he says.

One of Andrew's clients, Mary McEvoy Carroll of Menlo Park, had been paying $375 per month for a Health Net plan, with a $4,000 deductible, which is now being canceled. Her new ACA-compliant options ranged from $625 to $761 per month for a bronze plan. Andrew helped the 61-year-old Carroll sign up for a Cigna plan, and her new premium is $553 per month, with a $4,900 deductible. Andrew says this plan covers "annual wellness and preventive at 100 percent just like ACA compliant plans" and has "no less coverage overall" than plans sold on the exchange.

Carroll says she had supported the ACA, and tries "to be a good person, but 'this is for-the-greater-good philosophy' is hard to swallow when it has a large personal impact."

But buyer beware — Andrew says that Cigna will likely have a rate increase in early 2014. In California, no regulatory agency has the authority to reject rate increases. ACA-compliant plans can only change rates once a year. For consumers buying plans now on Covered California, their rates are guaranteed for all of 2014.

In addition, pre-ACA plans are all subject to medical underwriting, which allows insurers to turn people with specific conditions away, or charge them more or exclude coverage of certain conditions — a practice no longer permitted under the health law starting Jan. 1.

Carroll called the underwriting process "irritating and time consuming." She said she needed to dig up all her health records from the last 10 years, "then you get a phone call and you are asked ridiculous questions. I use a prescription cream for reduction of facial hair. It's not covered by insurance, but you have to admit to it."

The nurse who had called Carroll asked if she'd every had psychiatric counseling for the condition. "Can you imagine? 'Doctor, doctor, my facial hair is worrying me?" Carroll said with an astonished laugh.

About 900,000 Californians have had their policies canceled because they do not comply with the health benefits required by the ACA. Last month, the Covered California board voted unanimously that the cancellations will stand, no extensions would be permitted, as President Obama had requested. Canceled policies will terminate on Dec. 31.

Of those 900,000 people, about one-third of them are eligible for subsidies. People can determine if they are eligible for a subsidy in seconds using a calculator on the Covered California website. "If you're subsidy-eligible," said Andrew, "you're really going to benefit by enrolling in the exchange."

But those who are in the 1 percent of the Californians who have had their policies canceled and will pay more for comparable coverage might want to investigate these other options.